Tag Archives: refractory angina

Introduction Angina pectoris is the most common symptomatic manifestation of ischaemic heart disease (IHD), and is usually caused by an imbalance between myocardial oxygen supply and demand. Standard therapy for angina pectoris includes pharmacological agents, such as rate-limiting drugs and vasodilators. When symptoms are not satisfactorily controlled by pharmacotherapy alone, revascularisation via either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has been demonstrated to be of benefit in certain circumstances.1,2 While the majority of patients with angina pectoris can be managed successfully using a s

Introduction Papworth Hospital NHS Trust, Cambridge Spinal cord stimulation (SCS) therapy has been used for more than four decades in a variety of chronic pain conditions. The introduction of neurostimulation was a logical consequence of the ‘gate-control’ theory published in 1965.1 According to this model, the activation of large afferent nerve fibres inhibits pain input mediated by small fibres into the dorsal horn of the spinal cord. The goal of SCS is to attenuate discomfort by provoking paraesthesia in the same area. The European Society of Cardiology defines refractory angina as a chronic condition characterised by the presence of a

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Introduction Angina results from myocardial ischaemia as a consequence of mismatch between supply and demand.1 Most cases are secondary to atherosclerotic disease of coronary arteries.2 Conventional therapy to manage such patients has relied on pharmacotherapy and revascularisation strategies. Pharmacological options routinely include aspirin, statin, rate-limiting therapy, such as beta blocker or calcium-channel antagonist, and vasodilators, such as isosorbide mononitrate and nicorandil. Revascularisation may be through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).3 Chronic, refractory angina constitutes

Recommendations Members of the Canadian Cardiovascular Society have recently issued a position statement on refractory angina (RFA).2 They have produced three recommendations: Collect accurate data on the incidence and prevalence of RFA in Canada To have a clear definition of RFA that reflects recent advancements in pain neuropathophysiology To have joint CCS and Canadian Pain Society (CPS) guidelines. The group are awaiting the results of a publicly funded study looking at the prevalence of angina six months after percutaneous coronary intervention (PCI). They are also hoping to establish a registry as part of a joint project with the CCS

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